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Glossary

Indications

Fractures of the distal metaphysis can be transverse, oblique, or
comminuted.
Always confirm the fracture configuration in views from both planes.
Stable undisplaced fractures can be treated nonoperatively. Any displacement or
instability will usually require ORIF.
Other indications for ORIF are open fractures, or soft-tissue lacerations. In
these cases, ORIF is the best option.

Indirect reduction by traction

Reduction can be achieved by traction and flexion exerted by the surgeon, or
by two pointed reduction forceps.
Confirm reduction under image intensification.
Often, these fractures are stable after reduction. In such cases, nonoperative
treatment is indicated.

Direct reduction

Direct reduction is necessary when the fracture can not be reduced by
traction and flexion, or is unstable.
When indirect reduction is not possible, this is usually due to interposition
of parts of the extensor apparatus.
Use a pointed reduction forceps for direct reduction.

Preliminary fixation

Pointed reduction forceps, or a K-wire, may be used for preliminary
fixation. However, in many cases the position of the forceps, or the K-wire,
will conflict with the planned plate, or screw position.
For that reason, in many cases, the reduction is preliminarily held by an
assistant’s holding the finger in flexion. If the extensor apparatus is intact,
it will act as a tension band and hold the reduction.

Planning plate position

It is wise to use magnifying loupes for this step.
Plan the blade position as dorsal as possible, in order not to injure the
collateral ligament.
Make sure that the plate will be perfectly aligned with the long axis of the
proximal phalanx in the lateral view.

Determine location of drill hole

Trim the plate

Adapt the plate length to fit the length of the proximal phalanx. Avoid
sharp edges which may be injurious to the tendons. There should be at least 3
plate holes distal to the fracture available for fixation in the diaphysis. At
least two screws need to be inserted into the diaphysis.

Pearl: Cut the blade transverselyIf you cut the blade on the flat, it will compress and widen very
slightly as it is cut. This makes its maximal width very slightly larger than
1.5 mm. It may not fit in the 1.5 mm hole that you have drilled.
Therefore, cut the blade on edge (to deform it through its narrower dimension)
to the correct length. The resultant tip is somewhat arrow-shaped.

Prepare the blade

Pitfall: Protrusion of the blade

Avoid protrusion of the blade through the opposite cortex, as friction
during movement and eventual ligament injury may result.
Due to the fact that the phalanx is wider on the palmar side that on the dorsal
side, an AP or PA x-ray view may suggest that the blade is fully contained
within the bone, whereas in transverse section, it actually protrudes.